Two-point compression ultrasonography: Enough to rule out lower extremity deep venous thrombosis?

doi:10.5847/wjem.j.1920-8642.2021.04.003

Abstract

Abstract:

BACKGROUND: Deep venous thrombosis (DVT) is a major cause of morbidity and is a common presenting complaint to the emergency department (ED). Point-of-care two-point compression ultrasonography has evolved as a quick and effective way of diagnosing DVT. The purpose of this study is to validate the prevalence and distribution of venous thrombi isolated to proximal lower extremity veins, other than common femoral and popliteal veins in patients with DVT.
METHODS: This is a single-center retrospective study that looked at patients presenting to the ED of a tertiary care hospital between January 2014 and August 2018. The clinical presentation and laboratory and imaging results were obtained using the hospital’s electronic medical record.
RESULTS: A total of 2,507 patients underwent a lower extremity duplex ultrasound during the study period. Among them, 379 (15%) were included in the study. The percentages of isolated thrombi to the femoral vein and deep femoral vein were 7.92% and 0.53%, respectively. When the patients were stratified into the two groups of isolated DVT and two-point compression DVT, there were no statistically significant differences in the laboratory results between both groups. However, immobilized patients and patients with recent surgeries were more likely to have an isolated DVT.
CONCLUSIONS: Thrombi isolated to proximal lower extremity veins other than the common femoral and popliteal veins make up 8.45% of DVTs. Given this significant number of missed DVTs, the authors recommend the addition of the femoral and deep femoral veins to the two-point compression exam.

Key words: Lower extremity, Deep venous thrombosis, Emergency department, Two-point compression ultrasonography

Ralphe Bou Chebl, Nader El Souki, Mirabelle Geha, Imad Majzoub, Rima Kaddoura, Hady Zgheib. Two-point compression ultrasonography: Enough to rule out lower extremity deep venous thrombosis?[J]. World Journal of Emergency Medicine, 2021, 12(4): 268-273.

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Parameters	Value
Age, years, mean±SD	67±17
Gender, %
Male	53.56
Female	46.44
Smoking status, %
Non-smoker	72.03
Smoker	18.21
Ex-smoker	9.76
Alcohol consumption (yes), %	6.95
Allergy (yes), %	14.25

Parameters	Value
Risk factor profile, %
Hereditary hypercoagulable disorder	5.33
Malignancy	44.18
Recent surgery	14.55
Immobility/paralysis	15.78
Recent travel	1.81
Previous DVT	11.87
Symptoms, %
Pain	38.28
Swelling	63.64
Erythema	21.18
Warmth	11.93
AMS	4.22
Dyspnea	21.11
Fever	2.90
Weakness	7.12
D-dimer, ng/mL, mean±SD	5,757±16,356

Locations of thrombi	Percentage
Common femoral	7.12
Femoral	7.92
Deep femoral	0.53
Popliteal	12.66
Common femoral-femoral	9.50
Common femoral-femoral-popliteal	24.80
Common femoral-deep femoral-popliteal	0.26
Femoral-popliteal	16.62
Deep femoral-popliteal	0.53
Calf-proximal	16.89
Calf	3.17

Variables	Isolated DVT group (n=32)	Two-point compression group (n=347)	P-value
Age, years, mean±SD	65±17	67±21	0.452
Gender (female), %	47.26	37.50	0.289
Smoking status, %
Non-smoker	72.33	68.75	0.502
Smoker	17.58	25.00
Ex-smoker	10.09	6.25
Alcohol consumption (yes), %	6.41	12.90	0.255
Risk factors, %
Hypercoagulable hereditary disorder	5.25	6.25	0.684
Malignancy	44.22	43.75	0.959
Recent surgery	13.87	21.88	0.290
Pregnancy (among females)	1.83	0.00	1.000
Prolonged immobility/paralysis	15.20	21.88	0.322
Recent travel	1.97	0.00	1.000
Previous DVT	12.10	9.38	1.000
Symptoms, %
Pain	39.16	28.57	0.270
Swelling	65.74	39.29	0.005
Erythema	22.12	10.71	0.157
Warmth	12.33	7.41	0.755
AMS	3.75	9.38	0.144
Dyspnea	20.17	31.25	0.142
Fever	3.17	0.00	0.610
Weakness	7.20	6.25	1.000
D-dimer, ng/mL, median (interquartile range)	3,180 (1,190, 4,727)	2,006 (858, 4,784)	0.524

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